The impact of substance abuse on the development of active tuberculosis in HIV positive patients depending on their CD4 count

The objective of the study: to assess the risk to develop active tuberculosis in HIV infected patients with history of substance abuse taking into account their CD4 count.

Subjects and methods. A retrospective case-control study was conducted with enrollment of 171 patients: HIV Group included 85 persons, while TB/HIV Group – 86 persons. For screening for chronic alcohol/narcotic intoxication, the CAGE questionnaire was used, and tobacco dependence was detected according to the criteria of World Health Organization. CD4 counts were obtained by the retrospective analysis of medical records. The impact of the studied risk factors on the development of tuberculosis was estimated by calculating the odds ratio with the calculation of the 95% confidence interval.

Results. Statistically significant association with the development of active tuberculosis was obtained for all factors studied (tobacco smoking: OR = 8.7, 95% CI 3.6-21.6, p = 0.01; chronic alcohol and narcotic intoxication: OR = 3.5, 95% CI 1.8-6.5, p = 0.001 and OR = 2.5, 95% CI 1.1-5.4, p = 0.026, respectively). In the group of patients with CD4 count above 200 cells/µL, there was a confident effect of smoking and clinically significant substance abuse on the risk to develop active tuberculosis, and the power of their effect increased: for tobacco smoking OR = 12; 95% CI 1,5-98,7, p = 0.012; for drug abuse, OR = 4.8, 95% CI 1.7-13.4, p = 0.002. The tendency of chronic alcohol intoxication providing impact on the risk to develop tuberculosis in patients with CD4 count above 200 cells/μl persisted, but there was no statistically significant relationship in calculating the odds ratio OR = 3.1, 95% CI 3.1–9.6, p = 0.082. The obtained data allow considering people living with HIV and possessing history of substance abuse as a group facing the high risk to develop tuberculosis in need close follow-up aimed to prevent tuberculosis.

1. Belyakov N.А., Rassokhin V.V., Trofimova T.N., Stepanova E.V., Panteleev А.M., Leonova N.O., Buzunova S.А., Konovalova N.V., Milichkina А.M., Totolyan А.А. Co-morbid and severe forms of HIV infection in Russia. VICH-Infektsiya i Immunosuprssii, 2016, vol. 8, no. 3, pp. 9-25. (In Russ.)

2. Gorniy B.E., Kalinina А.M., Boytsov S.А. Detection of those with the risk of fatal alcohol abuse during dispensary check-up: methodological aspects. Profilakticheskaya Meditsina, 2015, vol. 18, no. 4, pp. 12-16. (In Russ.)

3. Zimina V.N., Batyrov F.А., Kravchenko А.V., Klimov G.V., Vasilyeva I.А. Clinical and X-ray specific manifestations of newly detected tuberculosis in HIV patients depending on the initial level of CD4 lymphocytes. Tuberculosis and Lung Diseases, 2011, no. 12, pp. 35-41. (In Russ.)

4. Recommendations no. 99/174 on express diagnostics (screening) of chronic alcohol intoxication in somatic patients, approved by the RF Ministry of Health as of 14.03.2000. (In Russ.)

5. Pokrovskaya А.V., Kozyrina N.V., Guschina Yu. Sh., Yurin O.G., Suvorova Z.K., Pokrovskiy V.V. Social demographic portrait of the patient living with HIV and attending AIDS Centers in Russia. Terapevticheskiy Arkhiv, 2016, no. 12, pp. 12-16. (In Russ.)

6. TB/VICH v Rossiyskoy Federatsii. Epidemiologiya, osobennosti klinicheskikh proyavleniy i rezultaty lecheniya. [TB/HIV in the Russian Federation. Epidemiology, specific clinical manifestations and treatment outcomes]. S.A. Sterlikov, eds., Moscow, RIO TSNIIOIZ Publ., 2017, 52 p.

7. Yakovlev А.А., Chayka N.А., Dzheffri Kelli, Musatov V.B., Аmirkhanyan Yu.А. Alcohol abuse and HIV infection. VICH-Infektsiya i Immunosuprssii, 2017, vol. 9, no. 4, pp. 17-32. (In Russ.)

8. Allen John P., Veronica B. Wilson. Assessing alcohol problems. A Guide for Clinicians and Researchers, second edition. National Institute on Alcohol Abuse and Alcoholism. 2003, 667 p.

9. Martin-Echevarria E., Rodrígues-Zapata M., Torralba M., Fernández J.M.R., Moreno A., Casado J.L., Dronda F., Pérez-Elías, Navas E., Moreno S. Incidence of tuberculosis in HIV-infected patients receiving HAART: interaction between TST and CD4 count. Int. J. Tuberc. Lung Dis., 2011, vol. 15, no. 10, pp. 1347-1352.

10. Miguez-Burbano M.J., Burbano X., Ashkin D., Pitchenik A., Allan R., Pineda L., Rodriguez N., Shor-Posner G. Impact of tobacco use on the development of opportunistic respiratory infections in HIV seropositive patients on antiretroviral therapy. Addiction Biology, 2003, vol. 8, no. 1, pp. 39-43.

11. Tønnesen P., Carrozzi L., Fagerström K.O., Gratziou C., Jimenez-Ruiz C., Nardini S., Viegi G., Lazzaro C., Campell I.A., Dagli E., West R. Smoking cessation in patients with respiratory diseases: a high priority, integral component of therapy. Eur. Respir. J., 2007, vol. 29, no. 2, pp. 390-417.

12. Van Zyl Smit R.N., Pai M., Yew W.W., Leung C.C., Zumla A., Bateman E.D., Dheda K. Global lung health: the colliding epidemics of tuberculosis, tobacco smoking, HIV and COPD. Eur. Respir. J., 2010, vol. 35, no. 1, pp. 27-33.

13. WHO, Methods for evaluating tobacco control policies. International agency for research on cancer. World Health Organization, 2008, vol. 12, 459 p.

14. WHO, The union monograph on TB and tobacco control: joining efforts to control two related global epidemics. World Health Organization, 2007, 86 p.

15. WHO, Global Tuberculosis Report 2018. World Health Organization, 2018, 265 p.